An Open Letter to the GOP From the People

Congratulations on controlling all three branches of our government, including both houses of Congress. We know you must be giddy with absolute power. By now, you might be asking yourselves whether you “should,” just because you “can.” In particular, do you really want to repeal Obamacare and replace it with one of your Republican plans? You apparently don’t care about those of us who didn’t vote for you. However, just consider a few reasons your Republican base will be angry:

OBAMACARE ISN'T UNPOPULAR: Only 5% of Republican voters considered Obamacare their #1 issue in the 2016 election. Now that they’ve tuned into Fox News and learned what’s in your replacement plans, they’re feeling uneasy. According to Fox, only 27% of Americans approve of your plan, while 52% approve of the plan they’d lose. That’s not a good direction to move. Declining poll numbers means Americans have changed their minds. We should have that right.

REPUBLICANS LIKE MEDICAID: You might not think there are any Republicans on Medicaid, but have you actually run the numbers? It turns out the president got 39% of the vote among Medicaid recipients! That’s impressive, and your party is to be congratulated for its clever messaging. Just be careful, because Republican voters actually have favorable views of Medicaid, by a 2:1 margin. How will you spin your message when several million Republicans are dumped from the program?

EMPLOYER-SPONSORED INSURANCE: Many Republican voters would lose their employer-sponsored group insurance when the employer mandate is abolished. It’s not as though employers would cut off that benefit overnight. However, as health care costs spiral upwards, and as businesses get leaner and leaner, going up against competition from China and India, this might become the trend. Will Republican workers be happy to “take one” for the company? Not likely.

THE WAITING PERIOD: The 6-12 month waiting period was a very creative way to incentivize continuity of coverage without an “odious” mandate. However, what’s going to happen when someone gets sick or injured, loses his or her job, and then has to find employment elsewhere? A lot of Republican voters are going to fall into that gaping hole at a time when they need their insurance the most.

CONSUMER VALUE: The pre-payable, refundable tax credits will help with premiums. Well done! And thank you for filling that hole you created between 0% and 100% of the Federal Poverty Level. Unfortunately vultures will be vultures. Most states will abolish the Medical Loss Ratio floor, so that insurers can charge higher premiums and gobble up all those tax credits in the form of higher margins. Consumers might not see much of the premium assistance you fought so hard to provide them, but they’ll know you tried. Just be grateful your party isn’t making you vote for the Cruz amendment. Your constituents would be livid upon discovering their Cruz plans didn’t qualify for tax credits after all.

STATE OPT-OUTS: Republican voters living in Sec. 1332 waiver states might discover their policies stop covering expensive things – cancer, heart disease, maternity care, even many medications. Then they would fully grasp the GOP’s sleight of hand concerning “preexisting conditions protections.” And there might no longer be out-of-pocket spending limits to protect the consumer. Instead, there might be annual and lifetime caps to protect the insurance companies. As frosting on the cake, opt-out states might not distribute tax credits in the way you intended. In some cases, states might not issue credits at all. We can’t really know what would happen, because it will be up to the states to decide. It would be completely out of your control. We have to trust the state legislators to act in our best interests, and they might not. We'd all know who to blame for giving them that power.

MARKETPLACE PLANS: What is to become of Americans buying non-group and small-group policies off the exchanges? Although that’s “only 7%” of the population, it is potentially an important group. These people are often the entrepreneurs who lack the freedom to start small business without a viable insurance marketplace, both for themselves and their employees. If they get priced out of the market, our economy would become less nimble – and the Republican base would decline.

The path forward is hazardous. Early in the week of July 24, you’ll be expected to vote on a motion to proceed to a floor debate on H.R. 1628. Does anyone know what amendments would be thrown down after passage of that motion? Would you be voting for a full repeal? Are you willing to take responsibility for the unwinding of our insurance markets and the consequences for American families? Do you really want to open that Pandora’s Box? Respectfully, there is no good news in anything your party has put forth so far, and there's even worse news in a repeal. And if you break it, you will own it. It will come back to haunt you in 2018 and 2020. This is the exact advice offered by former Sen. David Durenberger (R, Minnesota from 1978 to 1995).

In this age of political theater, there would be little satisfaction watching the political carnage unfold, even for those of us on the left. While your concern is political domination, our concern is the wellbeing of our families, friends, neighbors, and country. Republicans have ridiculed progressives for speaking in terms of death tolls, but that is literally what’s at stake. Shouldn’t that be obvious? When people lose their insurance and affordable access to medical care, some of them are going to die. Researchers even know the number: 1 excess death per year for every 830 uninsured people. If 22 million Americans go uninsured, 26,506 of them would die annually, simply because of this bill. That’s a September 11 event every 6 weeks. Are you ready to accept the blame for that? Because we will cast blame! More importantly, do you really want that to happen to our country?

Now is the time for us to come together as Americans with a common purpose. Instead of going down this destructive path, let’s do as both John McCain and the AMA have urged: Let’s sit down together, Republicans and Democrats, to fix the (minor) problems with our insurance markets, starting with a commitment to stop actively sabotaging them. Then let’s work on reducing health care costs. Your job isn’t to fight against each other. It is to work with each other constructively to solve the issues we face and to conduct the business of this nation.